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Research Article: Death by neurologic criteria and organ donation in German pediatric intensive care units—data from the PIA network

Date Published: 2026-10-23

Abstract:
Each year, between 250 and 300 children are listed for organ transplantation in Germany, while approximately 30 children donate organs. Despite identified barriers to pediatric organ donation, comprehensive data on characteristics and clinical management of pediatric deaths in German pediatric intensive care units (PICUs), especially among organ donors, remains limited. This study aims to analyze the epidemiology of in-PICU deaths and the characteristics of pediatric organ donors within a multicenter network of German PICUs. Retrospective analysis of data anonymously collected in 33 PICUs participating in the Pediatric Intensive Care Admission Network (PIA) between May 1, 2023 and July 31, 2025. Patients included were children older than 27 days and younger than 18 years who died during their PICU stay. Of 11,095 children recorded, 219 died (overall case-fatality rate:19.7/1,000). Median age at death was 6 years (IQR, 1– 13). Death occurred after withdrawal (30.1%) or limitation of life-sustaining treatment (20.5%), failed maximal therapy (26.5%) and failed cardiopulmonary resuscitation (12.8%). 21/219 (9.6%) children met neurologic criteria for death. Of these, 11 children became organ donors (52.4%). Median age of organ donors was 4 years (IQR 1–13). This first multicenter analysis from a nationwide German PICU network shows comparable mortality rates but substantially lower rates of death by neurologic criteria (DNC) in German PICUs than in international multicenter studies. This gap may indicate missed opportunities for organ donation. More structured donor identification, enhanced training for DNC diagnosis, and development of evidence-based guidelines for pediatric donor management may enhance quality of care and increase pediatric organ donation in Germany.

Introduction:
Each year, between 250 and 300 children are listed for organ transplantation in Germany, while approximately 30 children donate organs. Despite identified barriers to pediatric organ donation, comprehensive data on characteristics and clinical management of pediatric deaths in German pediatric intensive care units (PICUs), especially among organ donors, remains limited. This study aims to analyze the epidemiology of in-PICU deaths and the characteristics of pediatric organ donors within a multicenter network of…

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